Provider Demographics
NPI:1245351923
Name:FOSTER, SAMUEL C (DMD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:C
Last Name:FOSTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SO HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982
Mailing Address - Country:US
Mailing Address - Phone:978-468-5048
Mailing Address - Fax:978-468-4613
Practice Address - Street 1:78 WILLOW ST
Practice Address - Street 2:
Practice Address - City:SO HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982
Practice Address - Country:US
Practice Address - Phone:978-468-5048
Practice Address - Fax:978-468-4613
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA112831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics